Provider Demographics
NPI:1851928816
Name:CHUNG, EVAN (MD)
Entity type:Individual
Prefix:
First Name:EVAN
Middle Name:
Last Name:CHUNG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6260 EL CAMINO REAL STE 201
Mailing Address - Street 2:
Mailing Address - City:CARLSBAD
Mailing Address - State:CA
Mailing Address - Zip Code:92009-1609
Mailing Address - Country:US
Mailing Address - Phone:949-216-5277
Mailing Address - Fax:
Practice Address - Street 1:6260 EL CAMINO REAL STE 201
Practice Address - Street 2:
Practice Address - City:CARLSBAD
Practice Address - State:CA
Practice Address - Zip Code:92009-1609
Practice Address - Country:US
Practice Address - Phone:949-988-9034
Practice Address - Fax:949-403-8226
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-26
Last Update Date:2025-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA196337208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Multi-Specialty